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Need some pointers

My baby is 5 weeks old and my breastfeeding experience has literally been the most challenging thing I have ever gone through. I EBF the first 3.5 weeks and began supplementing with formula the 4th week per my pediatrician due to the baby not gaining enough weight. Talk about feeling like a failure. It literally broke my heart to have to introduce formula but nothing I did could put weight on her fast enough and she always seemed hungry despite nursing her on demand. My stress level hit an all time high and I feel like my milk production has been dwindling since. When I go to pump (for example, I have a hair appointment tomorrow and will be gone for several hours and will need her to have something while I am gone), I am pumping practically nothing (0.5-1.5 oz per breast, right more than left) and can barely make a 5-6 oz bottle in 2 days (my little girl is quite an eater- she has already taken 8 oz bottles-it is insane but I was the same way as a newborn). I typically nurse her from one breast for 20-30 minutes, which she seems content with most of the time, and pump the other to get the most milk- if I nurse her from both, I can barely pump anything.

Some background: I already have done oatmeal, barley (a beer here and there), mother's milk tea, all day pj sessions, skin to skin, etc as often as I can. I also gave up dairy at week 3 to see if that helped her gain weight/decrease fussiness and it seemed to help a bit. I only supplement her in the evening with 2-4 oz depending on what she takes and it is after nursing. I nurse her every 2-4 hours (on demand) for a minimum of 20 minutes per session, sometimes from both breasts, other times from just one, depending on my nipple discomfort level or if I need to pump later for a bottle.

So, getting to my questions:
Someone told me I should be pumping immediately after every feeding to increase my milk supply- is this true? What if I am pumping on nipples that won't give me milk? What is the best way to integrate pumping into increasing my supply?

Should I be nursing her from both breasts at every feeding? I am getting mixed advice.

Is there a chance my baby is colicky and I am interpreting her fussiness as hunger? In the evevning (5pm-11pm) she is nursing every 1-2 hours until bedtime (10pm ish) and screaming like she has never eaten before until I give her the supplementation bottle right before I put her down. The only thing that soothes her is my boob, but I can hardly keep up as my milk production is so low and feels like it is dwindling and the pain after nursing her so frequently gets me more irritated/stressed.

Re: Need some pointers

Welcome! I have to run pick up my big gal from school but I just want to say that everything you describe sounds fixable. Could you post a complete weight history for us? Birth weight, lowest weight, weight at each checkup? That can help us figure out if supplementing was appropriate advice for you. It would also help to know the following:
- How was your birth? Was labor induced, did you have IV fluids, did you have a c-section or any other difficulties?
- How does nursing feel? Is it comfortable or are you in any pain?
- Is baby sleepy or jaundiced at all?
- Do you hear a lot of swallowing when baby nurses, or is she just sucking lightly and intermittently?

Re: Need some pointers

- How was your birth? Was labor induced, did you have IV fluids, did you have a c-section or any other difficulties?
Induced 1 week post term, 30 hours and resulted in C-section as she would not descend. She was huge, 9lbs 2 oz, 21.5 inches, had pitocin and 4 L of IVF. She went to NICU because I spike a high fever during labor. I had a heck of a recovery.
- How does nursing feel? Is it comfortable or are you in any pain?
NUrsing was excruciating (tears, the whole bit) but had improved dramatically. Initial pain with latching that goes away. SHe tugs and pulls a lot while nursing, actutally cries on the nipple sometimes, but I can deal much better with the discomfort. She tends to go from a nice wide latch to a small gummy one that hurts her momma and I often have to hold the breast the whole feeding to assure she doesn't pull off
- Is baby sleepy or jaundiced at all?
No jaunduced or excessive sleepiness. Lots of crying
- Do you hear a lot of swallowing when baby nurses, or is she just sucking lightly and intermittently?
I hear gulping the first 10 minutes or so that slows into a gentle, mild sucking. Sometimes she is very fussy and gulps a lot, other times she is a little more gentle. Depends on her mood I guess. I assume the fussiness on my boob is frustration with the speed of my milk flow because it typically happens about 5 minutes or more into the feed, after my let down.

THANK YOU LADIES SO MUCH. I am so desperate for some support and coaching.
Also- no lactation consultant yet but have spoken on the phone with a LLLI representative serving the Philadelphia region.
Dana

Re: Need some pointers

Oh yeah-8lbs 8 oz at discharge, 8 lbs 6 oz at at 1st week weight check. 2nd week weight check was only at 8lbs 10 oz, 3rd weight check 8lbs 12 oz, 4th weight check (with some supplementing and no dairy) she was at 9lbs 3oz.
I was not a gestational diabetic, but I myself was a big baby. I am also average, slim build.

Re: Need some pointers

she has already taken 8 oz bottles-it is insane but I was the same way as a newborn).

Babies overfeed with bottles. It does not matter how much she takes, physiologically your baby's tummy is about the size of her fist.
I think you are overfeeding with bottles and that is making you concerend you do not make enough when in all likelyhood you do. Sometimes a slow weight gain is due to low supply, but also can be due to poor milk transfer or baby simply not nursing frequently enough.

A sleepy baby who has had lots of birth interventions may not nurse very effectively in the first couple of weeks or may sleep alot or otherwise not cue frequently enough, and a mom who is recovering from a difficult birth and major surgery may find it takes a bit longer for her milk to become abundant. This is a temporary situation, usually.

How often are you nursing? How many times in 24 hours? Frequent milk removal is the key to building milk supply. Switching breasts during a feed is also recommended for building supply but if your baby is satisfied with one side, I would not sweat it so much, I would just remember to nurse on the other side the next time-which should be very soon.

Pumping after every feeding is helpful for milk supply in some cases, particularly if baby is an inefficient nurser. But assuming baby is now able to latch well and nurse well, the very best way to build milk supply is to nurse nurse nurse and nurse some more. Try laid back positions (aka biological nurturing) that allow gravity to help prevent baby pulling off the nipple midfeed. Basically, if baby will nurse, and its comfortabel for you, I would suggest nursing rather than pumping. I don't like too many interventions like "pump such and such amount if time" that overwhelms & exhausts mom.

I cannot make heads or tails out of that weight history, hopefully Mommal has some insight. Considering the birth difficulties I would have expected a much larger initial weight drop. I wonder how many different scales we are talking here.

Re: Need some pointers

Thanks for answering those questions!

I agree with LLLMeg- those 8 oz bottles are too big. Believe me, I know how easy it is to overfeed a baby using a bottle because I did it with my first. I'd give her 3 oz, and she'd want more, so I'd give her 2 more oz, and then maybe 2 more, and then she'd puke, and then seem content for a while.

I'm also with her that there may have been something sketchy going on with the scales- if your baby was weighted on a whole bunch of diffent machines, offsets in calibration could explain a lot of why your baby didn't seem to be gaining weight fast enough. However, since you were in significant pain when nursing, and had such a difficult birth, I am inclined to suspect that there was either a supply issue or a milk transfer issue, or perhaps both.

But at this point, it sounds like nursing is going pretty well! You're not in pain, generally, right? Except in the evenings, when your LO nurses very frequently? (Please correct me if I am wrong.). And you're only giving one supplemental bottle per day, right at the fussy/colicky time of day when many, many moms end up supplementing due to the challenges of dealing with exceedingly cranky and confusing behavior. And you hear lots of swallowing when you nurse, which is great!

Here's what I think you want to do:
1. Contact your local LLL and ask for help. Specifically, I think you want a referral to a good lactation consultant, preferably an IBCLC. I think you want some hands-on help with latching, with pumping, and I think you'd really benefit from having someone watch you throughout a feeding, to see if there are any issues which are tripping you up. If your local LLL doesn't help you, call the Bryn Mawr Birth Center- they're right near you and I KNOW that someone there will refer you to the right person.
2. Pump after feedings, pumping enough every day that you can fill that supplemental bottle with your milk. Pumping after feedings, even if you're dry-pumping, will help increase supply. If you need to pump right now, make sure you're using the best possible pump. I suggest using a hospital-grade rental pump. If you want the best results, you want to use the best tools. Also, don't skimp on pumping sessions. The key to increasing supply is pumping frequently and emptying the breast as thoroughly as possible.
3. Rent a professional scale. It sounds like your biggest worry right now is milk supply, and doing several days' worth of weigh-feed-weigh records will help you determine exactly how much your baby is getting from you over the course of the day. If it's enough, you can stop supplementing and just nurse.

I think there is an excellent chance that you do not need to supplement at all. Extreme evening fussiness is easy to confuse with hunger, but if a mom has adequate supply at all other times of day, it's very unlikely that she is unable to make enough in the evening. Some things you can try instead of offering a bottle:
- nurse- you can't nurse too much!
- motion- rock in a rocker, swing in a swing, drive in the car, bounce on a ball, etc.
- white noise
- closeness- snuggle her in a sling, or close to your bare skin
- fresh air- bundle her up and take her outside
- warm water- an evening bath can really cut the fussing

Re: Need some pointers

It may sound like mommal and I disagree about the pumping so I will clarify-mommal is correct that pumping, even pumping when 'dry' -is considered helpful with building milk supply. My point was I think sometimesd moms have a hard time striking a workable balance. Some moms simply are too overwhelmed or exhausted to pump after every feed and if baby has nursed well, it may not be neccesary (imo) to pump that much. Again, as with nursing, it is the frequency of the pumping that is most important in building supply, not duration.

On all other points & suggestions I entirely agree esp. in getting help from an IBCLC is that is at all possible. You want someone to help you get that latch all the way comfortable, get more reasurance re: milk supply and also to discuss how to safely wean off formula.

One of the hardest things for moms who have been told to supplement is regaining their confidence about their abilities to meet their babies needs. So please remember mommal's tips. Babies fuss for many many reasons aside from hunger, and a baby may want to nurse very frequently at this age. That behavior does NOT mean baby is not getting enough. To tell if baby is getting enough we need to look at weight gain and output (poops.)